Interval Appendectomy Dr Shiva Sharma

Appendicitis - Inflammation of the appendix Appendiceal mass may refer to a phlegmon or abscess Diagnosis based on clinical and radiological examination Etiology Anyone with an appendix

Signs and symptoms Appendicitis Kosher’s sign: Initial epigastric/periumbilical pain that moves to the RIF course progresses McBurney point tenderness Anorexia Rebound Rigidity Guarding Psoas sign: RIF pain due to extension of the hip Rosving’s sign: LIF palpation causing RIF pain Obturator sign: flexion and internal rotation of the hip causing pain in the hypogastrium

Investigations History Clinical Exam Non-invasive Radiologic investigation Ultrasound CT scan

Interval Appendectomy for Appendiceal Masses Much debate on how to manage masses Antibiotics Radiographic guided drainage Surgery

Debate has been ongoing for many years as to whether or not surgery should be performed in the acute setting Now the general approach is to take a conservative approach and to treat with antibiotics Radioguided follow-up with ultrasonography to look for resolution of mass

Surgery Immediate Delayed/Interval – if patient clinically stable and good response to antibiotics If necessary at all? Why wait? Complications such as fistula, abscess, wound infections

Interval Appendectomy Disadvantages Repeat hospital admission Shorter length of stay Vargas et al American Surgery 1994 Initial stay 7.6days, 2nd stay 1.4days with interval appendectomy

Advantages Unfavourable surgical conditions avoided Post operative complications avoided Definitive diagnosis Length of hospital stay post operative shorter Missed diagnosis avoided Hoffman et al. American Journal of Surgery 1984 59 patients, 3 caecal carcinoma and lymphoma found Recurrent appendicitis, 9patients

Conclusion